In Singapore, it is standard practice for patients who have had a heart attack or stroke to be prescribed a daily low-dose of aspirin (100mg). However, in some countries, such as the United States, people who have never had an attack previously also habitually took aspirin daily because they believe this would prevent a first heart attack.

A heart attack occurs when one of the arteries that supplies blood to the heart becomes blocked due to a blood clot, stopping blood flow to the heart muscle. Aspirin thins the blood, and thus lowers the risk of a second heart attack or stroke by reducing the chance of blood clot formation. This is why low-dose aspirin is prescribed to patients who have experienced a heart attack or stroke.

However, aspirin can also increase the chances of bleeding. “Blood clots are the body’s way of stopping bleeding. Aspirin interferes with this, and so makes a person who is taking aspirin more prone to bleeding,” said Associate Professor Chin Chee Tang, Senior Consultant, Department of Cardiology, and Director of Coronary Intervention Service, National Heart Centre Singapore (NHCS).

Patients who are prescribed aspirin are advised to be vigilant for signs of bleeding and symptoms of internal bleeding, which may also happen in the intestinal tract or stomach. This may be presented in black sticky stools, or some people may feel tired and lethargic with no apparent reason.

While patients on aspirin may be more susceptible to cuts and bruises, the effects are usually mild. For instance, applying pressure on a wound a little longer stops the bleeding if the patient has a cut; bruises may appear slightly larger, but they, too, should resolve with time. Some people are allergic to aspirin and may have reactions such as swollen eyes and rashes, but these are uncommon.

If patients experience severe gastric irritation with use of aspirin, they should discuss with their doctor for possible solutions, such as taking gastric protection pills or switching to another blood thinner.

“What is important is that the use of aspirin must be administered to the correct population. For patients with a previous heart attack or stroke, aspirin has helped reduce the incidence of heart attacks and even death,” said Assoc Prof Chin.

“One should not start taking aspirin without consulting a doctor. An individual’s medical history and patient profile have to be taken into account before the doctor recommends aspirin,” he added.

Beyond medications, there are other methods to reduce the risk of a heart attack. By controlling one’s risk factors, there may not be a need to take additional medications. Therefore, it is important to keep blood pressure and cholesterol levels under control, avoid smoking, maintain a diet that has a healthy proportion of fruits and vegetables, and reduce the consumption of trans fats.

A mix of aerobic and strength exercises, performed regularly for 30 to 45 minutes most days of the week, will help build overall fitness, improve mental well-being, and has been shown to reduce the risk of heart attacks.

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